Bronchoscopy

Mr. Husain Nadaf, Tutor

1. PROCEDURE ON BRONCHOSCOPY GUIDED BY: MRS. MANISHA SAMUDRE ASSISTANT PROFESSOR HOD OF MEDICAL- SURGICAL NURSING

2. WHAT IS BRONCHOSCOPY Bronchoscopy is a technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument ( bronchoscope ) is inserted into the airways, usually through the nose or mouth , or occasionally through a tracheostomy . This allows the practitioner to examine the patient's airways for abnormalities such as foreign bodies , bleeding , tumors , or inflammation . Specimens may be taken from inside the lungs.

3. BRONCHOSCOPE A bronchoscope is a soft (flexible) tube with an outer diameter as small as 2.2 mm and there are larger sizes for use with larger children and adults, with a tiny camera on the end which is inserted through the nose (or mouth ) into the lungs. During a bronchoscopy procedure, a scope will be inserted through the nostril until it passes through the throat into the trachea and bronchi.

4. The diagnostic procedures of bronchoalveolar lavag e, transbronchial needle aspiration (TBNA ), and transbronchial biopsy can be performed during a bronchoscopy .

5. THERAPEUTIC BRONCHOSCOPY Bronchoscopy can also play a therapeutic role. For example, bronchoscope can be used in the treatment of airway obstruction by tumors or foreign bodies , during the removal of secretions

6. TYPES OF BRONCHOSCOPY Flexible Bronchoscopy - Flexible bronchoscope uses a long , thin , lighted tube to look at your airway. The flexible bronchoscope is used more often than the rigid bronchoscope because it usually require local oral anesthesia is more comfortable for the person , and offers a better view of the smaller airways . It also allows to remove small samples of tissue (biopsy).

7. The flexible tube actually contains a fiber-optic system which attaches to a video camera and a source of light. The light travels through the scope and lights up the inside of the airway. The image seen at the tip of the scope is transmitted back again through the fiber-optic system to the video camera. Using Bowden cables connected to a lever at the hand piece , the tip of the instrument can be oriented , allowing the practitioner to navigate the instrument into individual lobe or segment bronchi . Most flexible bronchoscopes also include a channel for suctioning or instrumentation, but these are significantly smaller than those in a rigid bronchoscope.

8. FLEXIBLE BRONCHOSCOPY

9. Rigid Bronchscopy - Rigid bronchoscopy is usually done with general anesthesia and uses a straight, hollow metal tube. It is used for: When there is bleeding in the airway that could block the flexible scope's view. To remove large tissue samples for biopsy. To clear the airway of objects (such as a piece of food) that cannot be removed using a flexible bronchoscope.

10. RIGID BROCHOSCOPY

11. INDICATIONS Lesions requiring biopsy seen on chest X-ray. Hemoptysis & Stridor . Positive sputum cytology for malignant cells Collection of bronchial secretions for bacteriology, especially Tuberculosis. Recurrent laryngeal nerve paralysis of unknown etiology. Infiltrative lung disease (to obtain a transbronchial biopsy). Investigation of collapsed lobes or segments and aspiration of mucus plugs.

12. PRE PROCEDURAL The patient is starved overnight. Explain the procedure to the patient and relatives Obtain written consent of the patient or relatives Remove dentures, contact lenses and other prostheses Ask the patient not tosmoke for at least 24 hours.

13. PROCEDURE All patients require sedation to tolerate the procedure (risk of cardiopulmonary arrest) Minor and transient cardiac dysrhythmias occur in up to 40% of patients on passage of the bronchoscope through the larynx. Monitoring is required. Oxygen supplementation is required

14. Atropine 0.6 mg IM is given 30 min before the procedure, as an anticholinergic ( muscarinic ) to decrease the respiratory secretions, and to prevent oral secretions from obstructing the view Topical anesthesia ( lidocaine 2% gel) is applied to the nose, nasopharynx and pharynx, to anesthetize the mucous membranes of the pharynx, larynx, and trachea Intravenous sedation (e.g. diazepam 10 mg or midazolam 2.5–10 mg) is given.

15. You may be asked to take a deep breath & bronchoscope is passed through the nose, nasopharynx and pharynx under direct vision to minimize trauma. Lidocaine (2 mL of 4%) is dropped through the instrument on to the vocal cords. The patient is monitored during the procedure with periodic blood pressure checks, continuous ECG monitoring of the heart, and pulse oximetry .

16. An X-ray machine (fluoroscope) may be placed above you to provide a picture that helps you to see any devices, such as forceps to collect a biopsy sample, that are being moved into your lung. All segmental and subsegmental orifices should be identified. After finishing the scopy A salt (saline) fluid may be used to wash your airway, and then the samples are collected and sent to the lab to be studied.

17. AFTER CARE Although most patients tolerate bronchoscopy well, a brief period of observation is required after the procedure, So Close monitoring for 2-4 hours Eating and drinking is not allowed until whole anesthesia is worn off & and gag reflex has returned. Advise for an post X-ray to see possible complications of post- bronchoscopy for e.g. pneumothorax Asses the patient with vital signs and level of consciousness Request patient strictly not to drive for at least 8 hours after the procedure. Spit out your saliva until you are able to swallow without choking.